General Provisions

(1) Scope, Purpose, and Effective Date. 101 CMR 339.00 governs the rates of payment to be used by all governmental units for rehabilitation center services and restorative services provided to publicly aided individuals by eligible providers. Rates for services rendered to individuals covered by M.G.L. c. 152 (the Workers’ Compensation Act) are set forth at 114.3 CMR 40.06(12): Restorative Services Description. (2) Applicable Dates of Service. Rates contained in 101 CMR 339.00 apply for dates of service provided on or after June 6, 2025. (3) Coverage. Except as provided otherwise, 101 CMR 339.00 and the rates of payment contained in 101 CMR 339.00 apply to services rendered by eligible providers of rehabilitation center services and eligible providers of restorative services to publicly aided individuals. The rates of payment specified in 101 CMR 339.00 are full compensation for professional services rendered, as well as for any administrative or supervisory duties. (4) Exceptions. Rates of payment contained in 101 CMR 339.00 do not apply to indirect services, such as case conferences or in-service education programs provided by eligible providers in long-term-care facilities. (5) Coding Updates and Corrections. EOHHS may publish procedure code updates and corrections in the form of an administrative bulletin. The publication of such updates and corrections will list (a) codes for which only the code number has changed, with the corresponding cross-reference between new and existing codes; (b) codes for which the code remains the same, but the description has changed; (c) deleted codes for which there are no corresponding new codes; and (d) entirely new codes that require new pricing. EOHHS may list these codes and price them at a percentage of the prevailing Medicare fees, when Medicare fees are available. When Medicare fees are not available or when otherwise designated by EOHHS, EOHHS may apply individual consideration in reimbursing for these new codes until appropriate rates can be developed. (6) Administrative Bulletins. EOHHS may issue administrative bulletins to clarify its policy on and understanding of substantive provisions of 101 CMR 339.00. (7) Disclaimer of Authorization of Services. 101 CMR 339.00 is not authorization for or approval of the procedures for which rates are determined pursuant to 101 CMR 339.00. Governmental units that purchase care are responsible for the definition, authorization, and approval of care and services extended to publicly aided individuals.